Expert suggests short cut to recovery

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You've heard of placebo pills, but one the world's leading medical experts now advocates the benefits of placebo surgery.

The editor of the British Medical Journal, Richard Smith, says placebo surgery - where patients in a trial don't know if they've had an operation or not - was sometimes as effective as the real thing.

Dr Smith, who presented a paper on the topic at the Royal Australasian College of Surgeons congress in Melbourne yesterday, said placebo surgery could provide better evidence of the effectiveness of a procedure and reduce the number of patients having unnecessary surgery.

He cited as an example a trial published in the New England Journal of Medicine in 2002 of 185 patients undergoing an arthroscopy for arthritis. Half had the operation to clean out a joint, and the other half were given an incision and nothing else. They were followed up for two years, in which researchers found little difference between the groups.

"So here's something that was being done commonly, that was costing a lot of money, that seems to have had no benefit whatsoever," Dr Smith said.

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He believes too many procedures are performed with little evidence of their effectiveness. This contrasts with the often costly and long-running process required to produce evidence to get a new drug approved for sale. "Whereas if tomorrow you dream up a new surgical operation, then ba-boom, away you go," Dr Smith said.

Hysterectomy was another operation with enormous variations in the numbers performed, even within one country, he said. "It correlates mostly with the number of surgeons or the number of gynaecologists, and I think there are a lot of hysterectomies that have been done for really very poor reasons," Dr Smith said.

Another example was tonsils, now rarely removed.

He acknowledged there were problems with placebo surgery. For example, it would be difficult to conceal from patients whether or not they had had some procedures, and giving anaesthetic without performing surgery also carried risks. "But then the argument against it is that to carry on doing an operation on lots and lots of people, thinking it has benefit when it probably doesn't, is a pretty unfortunate thing to do as well," he said.